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Galli, John NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John Galli Male Date of Death Age If Veteran of U.S.Armed Forces, 04/04/2020 76 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Mineola Village Street Address Winthrop University Hospital p Manner of Death © Natural Cause Accident Homicide Suicide Undetermined ❑Pending W Circumstances Investigation U W Medical Certifier Name Title Roman Liberman MD Address 259 1 st Street,Mineola Village,New York 11501 Death Certificate Filed District Number Register Number City,Town or Village Mineola Village 2908 269 ❑Burial Date Cemetery,Crematory or Facility Name 04/13/2020 Pineview Cemetery and Crematorium Entombment Address XV 10011 Cremation Queensbury Hamlet,New York ❑Donation Z Removal Date Place Removed p and/or and/or Held N Hold Address O 0- Date Point of to Transportation Q by Common Shipment Carrier Destination EjDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home N F Walker Inc 01234 Address 2039 Merrick Avenue,Merrick Hamlet,New York 11566 Name of Funeral Firm Making Disposition or to Whom I- Remains are Shipped,If Other than Above 2 Address it a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/07/2020 Registrar of Vital Statistics WayneYfenry Wink(ECectronicaffy Signed) /signature/ District Number 2908 Place Mineola Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition 1'� Z070 Place of Disposition hettko� ky✓� (address) W N (section) (lotnumber) (grave number) oC��is�� sE0�E Name of Sexton or Person in Charge f Premises Z (please print) W Signature Title C DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) f1 Receipt Human remains of delivered on , 20 r Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#